VATI RN COMPREHENSIVE PREDICTOR FOCUSED REVIEW
Management of Care – (9)
Advance Directives – (1)
▪ Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4)
• A living will is a legal document that expresses the client’s wishes regarding medical treatment in the event the...
VATI RN COMPREHENSIVE
PREDICTOR FOCUSED
REVIEW
❖ Management of Care – (9)
➢ Advance Directives – (1)
▪ Legal Responsibilities: Purpose of a Living Will (RM FUND 9.0 Chp 4)
• A living will is a legal document that expresses the client’s wishes regarding
medical treatment in the event the client becomes incapacitated and is facing end-
of-life issues. Most state laws include provisions that protect health care providers
who follow a living will from liability.
➢ Assignment, Delegation and Supervision – (2)
▪ Delegation and Supervision: Delegating Tasks to an Assistive Personnel (RM FUND
9.0 Chp 6)
• Examples of tasks nurses may delegate to Aps (provided the facility’s policy
and state’s practice guidelines permit)
◆ Activities of daily living (ADLs) – bathing, grooming, dressing, toileting,
ambulating, feeding (without swallowing precautions), positioning
◆ Routine tasks – bed making, specimen collection, intake and output, vital
signs (for stable clients)
▪ Managing Client Care: Delegation Strategy for Effective Task Management
(RM Leadership 7.0 Chp 1)
• Consideration for selection of an appropriate delegate include the following:
education, training, and experience; knowledge and skill to perform the task; level
of critical thinking required to complete the task; ability to communicate with
others as it pertains to the task; demonstrated competence; the delegatee’s culture;
agency policies and procedures and licensing legislation (state nurse practice acts)
➢ Case Management – (1)
▪ Cardiovascular Disorders: Tetralogy of Fallot (RM NCC RN 10.0 Chp 20)
• Tetralogy of Fallot – four defects that result in mixed blood flow: Pulmonary
stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
◆ Cyanosis at birth: progressive cyanosis over the first year of life. Systolic
murmur. Episodes of acute cyanosis and hypoxia (blue or “Tet” spells)
• Surgical procedures – shunt placement until able to undergo primary
repair; complete repair within the first year of life
➢ Collaboration with Interdisciplinary Team – (1)
▪ Communicable Diseases, Disasters, and Bioterrorism: CDC Reportable
Diagnoses (RM CH RN 7.0 Chp 6)
• Anthrax. Botulism. Cholera. Congenital rubella syndrome (CRS). Diphtheria.
Giardiasis. Gonorrhea. Hepatitis A, B, C. HIV infection. Influenza-associated
pediatric mortality. Legionellosis/Legionnaires’ disease. Lyme disease. Malaria.
Meningococcal disease. Mumps. Pertussis (whooping cough). Poliomyelitis,
paralytic. Poliovirus infection, nonparalytic. Rabies (human or animal). Rubella
(German measles). Salmonellosis. Severe acute respiratory syndrome-associated
coronavirus disease (SARS-CoV). Shigellosis. Smallpox. Syphilis. Tetanus/C.
tetani. Toxic shock syndrome (TSS) (other than Streptococcal). Tuberculosis
, (TB). Typhoid fever. Vancomycin-intermediate and vancomycin-resistant.
Staphylococcus aureus (VISA/VRSA)
➢ Continuity of Care – (1)
▪ Information Technology: Change-of-Shift Report (RM FUND 9.0 Chp 5)
• Nurses give this report at the conclusion of each shift to the nurse assuming
responsibility for the clients.
◆ Formats include face to face, audiotaping, or presentation during walking
rounds in each client’s room (unless the client has a roommate or visitors
are present)
◆ An effective report should: include significant objective information about
the client’s health problems; proceed in a logical sequence; include no gossip
or personal opinion; relate recent changes in medications, treatments,
procedures, and the discharge plan
➢ Establishing Priorities – (1)
▪ Managing Client Care: Determining Priority Care for a Group of Clients (RM
Leadership 7.0 Chp 1)
• Prioritize systemic before local (“life before limb”)
◆ Prioritizing interventions for a client in shock over interventions for a client
who has a localized limb injury
• Prioritize acute (less opportunity for physical adaptation) before chronic (greater
opportunity for physical adaptation)
◆ Prioritizing the care of a client who has a new injury/illness (e.g. mental
confusion, chest pain) or an acute exacerbation of a previous illness over
the care of a client who has a long-term chronic illness
• Prioritize actual problems before potential future problems
◆ Prioritizing administration of medication to a client experiencing of
medication to a client experiencing acute pain over ambulation of a client at
risk for thrombophlebitis
• Listen carefully to clients and don’t assume
◆ Asking a client who has a new diagnosis of diabetes mellitus what he feels is
most important to learn about disease management
• Recognize and respond to trends vs. transient findings
◆ Recognizing a gradual deterioration in a client’s level of consciousness
and/or Glasgow Coma Scale score
• Recognize indications of medical emergencies and complications vs.
expected findings
◆ Recognizing indications of increasing intracranial pressure in a client who has
a new diagnosis of a stroke vs. the findings expected following a stroke
• Apply clinical knowledge to procedural standards to determine the priority action
◆ Recognizing that the timing of administration of antidiabetic and
antimicrobial medications is more important than administration of some
other medications
➢ Ethical Practice – (1)
, ▪ Professional Responsibilities: Demonstration of Veracity (RM Leadership 7.0 Chp 3)
• Veracity: the nurse’s duty to tell the truth
➢ Legal Rights and Responsibilities – (1)
▪ Professional Responsibilities: Rights of Clients (RM Leadership 7.0 Chp 3)
• Client rights are the legal guarantees that clients have with regard to their health
care
◆ Clients using the services of a health care institution retain their rights as
individuals and citizens of the United States. The America Hospital
Association (AHA) identifies client rights in health care settings in the Patient
Care Partnership (www.aha.org)
◆ Residents in nursing facilities that participate in Medicare programs similarly
retain resident rights under statutes that govern the operation of these facilities
• Nurse are accountable for protecting the rights of clients. Situations that require
particular attention include informed consent, refusal of treatment, advance
directives, confidentiality, and information security.
❖ Safety and Infection Control – (5)
➢ Accident/Error/Injury Prevention – (2)
▪ Medications Affecting Urinary Output: Indications for the Use of a Diuretic
(RM Pharm RN 7.0 Chp 19)
• High-ceiling loop diuretics work in the ascending limb of loop of Henle – block
reabsorption of sodium and chloride and prevent reabsorption of water. Causes
extensive diuresis even with severe renal impairment
• They are used when there is an emergent need for rapid mobilization of fluid –
pulmonary edema caused by heart failure; conditions not responsive to other
diuretics, such as edema caused by liver, cardiac, or kidney disease; or
hypertension
◆ Unlabeled use – hypercalcemia
▪ Seizures: Maintaining Seizure Precautions (RM NCC RN 10.0 Chp 13)
• Seizure precautions for any child at risk – pad side rails of bed, crib, and
wheelchair; keep bed free of objects that could cause injury; have suction and
oxygen equipment available
➢ Handling Hazardous and Infectious Materials – (1)
▪ Cancer Treatment Options: Implanted Internal Radiation Device (RM AMS RN
10.0 Chp 91)
• Brachytherapy describes internal radiation that is placed close to the target tissue.
This is done via placement in a body orifice (vagina) or body cavity (abdomen) or
delivered via IV such as with radionuclide iodine, which is absorbed by the
thyroid
◆ Brachytherapy provides radiation to the tumor and a limited amount to
surrounding normal tissues. Waste products are radioactive until the Isotope
has been completely eliminated from the body. Waste products should not
be touched by anyone.
• Nursing Considerations
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